68-767 - Laserfiche WebLink

Home Browse Search

FGR OFFICE USE: PPLICATION FOR SANITATION PERMIT Permit No. 71G-7 -------------- ----------------- ------- ----------- (Complete in Triplicate) - -- ------ --- ------------------ r Date Issued This Permit Expires 1 Year From Date issued Application is €r� made to tiie Sari Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. C JOB ADDRESS/LOCATION - - --..----CY----- N1,-G ,C1 4 i1/A L L7 . _CENSUS TRACT ------ ----------•-------- __.--/7_------ Owner's NameJV ^ -G�. _n : a 0 fy' 5r� � ra^! Address 1 v'------ +?"3 d --------------------------------------------- � . ! Contractor's Name/----- � f_ -------- � '5-- ----- #I/--3-2__4--9--- Phone Installation will serve- Residence ❑ Apartment House❑ Commercial ❑Trailer Court ❑ i Motel ❑ Other --- - -----C-A}`vt P ----------- Number of living units:------------ Number of bedrooms ---------___Garbage Grinder -_-----_ Lot Size -------------------_ Priva#e 4 Water Supply: Public System and name ------------------------------------------ ---- !W Character of soil to a depth of 3 feet: Sand'❑ Silt®' Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe-❑ Fill Material --------- -- If yes,type ---------------------------- Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on�reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK:[ � r Size------------------------------------------ ---- Liquid:�Depth'--- U ' _ W --------------------- ()__)D ----------------- ��---� MterialCapacity Type W-0 - -- a �+I No. Compartments i Distance to nearest: Well 3'_d 0----------------_1_Foundation �a_Q_---------- Prop. Line -_-____.._____..___.._ { LEACHING UNC No. of Lines ..... o. __-- -- --- Length 'of each line--- a- ---___ Total Length ------- -------- c 'D' Box ------------ Type Filter Material --------------------Depth Filter Material ---------------------------------------_ l i Distance to nearest: Well ------------------------ Foundation __ x ----------------- Property Line. --------------- Roc ❑ -----•• Rock Filled Yes No ❑ SEEPAGE PIT [ ] Depth ----- ------ - ----- Diameter ---------------- Number ------------------ ----I r Water Table Depth -------------- 8------------------------------Rock Size / -----------------� _ Foundation Pro line ---------------------- Distance to nearest: Well _________________ __ ------------------- p - ------------------ ' ----------------- Date --------------------------------- ) REPAIR/ADDITION(Prev. Sanitation Permit# -------- -------------�- - Septic Tank (Specify Requirements) --------- --------- ---------------------------------------------------------- --•-------------------------------------------------------•- Disposal Field {Specify Requirements) ----------- --------------------=--y--------- - �---------------- --------------------------------------- ---------- � --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I ----------- ------ -------------- (Draw existing and required addition on reverse side) { I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin t County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to beco a sub" ct to Workman's Co fipensation laws of California." Signed f---- --- - - ------------ -- --------------- Owner S � P BY ._.. - ------------- Title C'� �r (If other than owner) k FOR DEP T T SE APPLICATION ACCEPTED BY ---------------------------------- - DATE -- ---- ---------- ------------------ BUILDING PERMIT ISSUED -- D E ADDITIONAL COMMENTS ----------- ------------------ --------------------------------------- --------------------------- ------------------ ---------------------- -Date -------,-------------- ------------- Final Inspection b -------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M